Preventive Care is
important to your health
Health Benefits & Coverage
Understanding Your Preventive Care Benefits
As mentioned in your benefits booklet, many screenings and tests are covered at 100% with no out-of-pocket costs to you as part of your health plan. Use your covered preventive care and stop many health problems before they get serious.
Know before you go:
Preventive Care Can Help You Stay Healthy
What is preventive care?
Preventive care (sometimes referred to as “preventative care”) is routine health care that includes screenings, services and patient counseling to help prevent illness, disease or other health problems. It’s covered by your plan because it helps you stay healthy and lets you know if you may develop a health problem.
Don’t let disease sneak up on you. Preventive care might just save your life.
“I don’t have time to go to the doctor when I’m not sick.”
Medical care when you don’t “need” it can feel like a waste of time. But it’s not.
Preventive care can reveal a health problem before you have any symptoms — when it can be more easily treated.
Which Types of Services Are Covered at 100%?
Preventive care that is 100% covered includes many important services like the ones listed below. This list is not complete, so please see the full list of preventive care services and any limitations on the Men, Women and Children pages.
- Screenings and tests
- Cancer screenings, such as colon, breast and cervical
- Blood pressure
- Well-baby and well-child visits
- Counseling and support
- Tobacco cessation
- Alcohol misuse
- Sexually transmitted infections
- Immunizations, like the flu shot
To be covered with no out-of-pocket costs, the service must be:
- Provided by an in-network doctor or facility (urgent care facility, outpatient clinic or ambulatory surgery center)
- Filed by your doctor as a preventive care visit
- Identified as preventive care under the Affordable Care Act (ACA)
What Else Do I Need to Know?
Below are examples of common services your doctor may do that are not identified as preventive care by the ACA so are not 100% covered. These services may cost you money at your doctor's office or lab:
- Hormone tests
- Vitamin D tests
- Chest X-rays
- Thyroid tests
- EKGs (electrocardiograms)
*NOTE: You should feel free to ask questions about your health. Tell your doctor that you are on a preventive care visit when you want to ask about a problem you are having. If you do not, your doctor may label the discussion as diagnostic (and not preventive), which may cost you money.
Sometimes you go to the doctor for preventive care and end up with an extra charge on your bill. You can be prepared for your appointment by following these steps:
- When you schedule your appointment, say that you want preventive care screenings and tests that are 100% covered by your plan.
- Ask if any tests or treatments provided during your appointment might not be considered preventive care.
- Ask if talking about other topics that are not considered preventive care during your appointment will lead to extra costs.
- Ask if any lab work can be sent to a BCBSNC in-network lab to lower your costs.
The Affordable Care Act (ACA) has identified certain services as preventive care to be paid at 100%.
- These benefits are available for members of non-grandfathered individual health insurance plans.
- If you get benefits from your employer, you may also have these benefits. If your Summary of Benefits section of your Benefit Booklet contains PREVENTIVE CARE covered under federal law, then you have these benefits at no charge IN-NETWORK.
- These benefits are currently in effect unless otherwise noted.
- Check your Benefit Booklet for details on other preventive care benefits.
- This information is a reference tool and does not guarantee payment of any claims.